Provider Demographics
NPI:1033455183
Name:SOYRING, KELLY J (OTR)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:J
Last Name:SOYRING
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:HAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18580 TOTLAND RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-7603
Mailing Address - Country:US
Mailing Address - Phone:955-955-2218
Mailing Address - Fax:
Practice Address - Street 1:18580 TOTLAND RD
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-7603
Practice Address - Country:US
Practice Address - Phone:955-955-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104154225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist